Strong Demand for Physician Assistants at Retail Clinics – 8/30/2012

What do pharmacy giants CVS Caremark and Walgreen Co., retailer Target Corp. and grocery store chain Kroger all have in common? They all hire physician assistants.

As unlikely as it seems, the companies don’t just sell drugs, housewares and six-packs. They are on the forefront of a new type of healthcare delivery of services called retail medicine. Through their MinuteClinics, Little Clinics and Take Care Clinics, they are putting a new face on primary care by offering convenient, low-cost patient care.

The estimated 1,350 in-store clinics nationwide are growing rapidly and according to some reports could rise to 3,000 by 2016. They are popular with patients who can stroll in without an appointment seven days a week for such routine care as ear infections, school physicals and flu shots.

Most clinics are staffed by mid-level providers – physician assistants (in states where they are allowed) and nurse practitioners. The providers collaborate with a physician but usually work alone.

New grads out of physician assistant school are among the professionals the retail clinics seek as they staff up. But it’s important that they know the pros and cons of this type of employment before signing up.

At the clinics, PAs work with supervising physicians (according to applicable state laws) to diagnose and treat common illnesses and minor injuries, prescribe medication, perform physicals and health screenings and counsel on health and nutrition. They can perform a physical for a high-schooler trying out for the football team, or treat a case of poison ivy.

The model is primarily targeted at people needing care that day and is designed to provide an alternative to the emergency room – or to the family practitioner who isn’t available. Many of the consumers don’t have a primary care home.

Usually visits are considered by insurers as an in-network so they are covered; uninsured pay from $70 to $90 a visit.

Scope of care

They aren’t designed to treat complex problems such as stitching up deep wounds or setting fractures, gynecological care, or doing extensive diagnostic tests.

“It’s a wonderful concept that fills an important need,” says Stephen E. Lyons, MS, PAC-C, DFAAPA, who until earlier this year worked for one of the large chains in Nevada. “But the kinds of problems dealt with in convenient care are very limited in terms of scope of practice.”

Nationally only a fraction of new PA grads go into retail clinic or urgent care, says Anthony Brenneman, MPAS, PA-C, program director of the physician assistant studies department at the University of Iowa, but the numbers are increasing.

“These urgent care clinics are definitely a potential place for new graduates as well as seasoned practitioners wanting a different style of work environment then they may have in a clinic setting. They provide same-day care, but are not designed to become the medical home for a patient, so in this sense they function more like an emergency room, but don’t see the higher acuity of patient that the emergency room sees.”

One of the chains that has opened 11 new clinics this year is The Little Clinic, which in 20120 became part of the The Kroger Co. Started in 2003, the company now has 88 clinics in Kroger, Fry’s, and King Soopers stores in Ohio, Kentucky, Tennessee, Arizona, Georgia and Colorado.

Sharon Marti, vice president of operations, said the company is “absolutely” looking to hire new grads in four states (its clinics in Ohio and Georgia do not employ physician assistants).

“It’s a wonderful career opportunity to build your own practice and patient base,” she says.

Marti says the physician shortage is driving the expansion of retail clinics. “There are not enough physicians to do what needs to be done; 60 percent of our patients do not have a primary care doc. The demand is there.”

While acknowledging that that the scope of practice may be limited for PAs, she nevertheless hires only top-notch, highly skilled practitioners. “They have to be really skilled at the services we provide. That’s because of their autonomy – they don’t have someone down the hall to ask questions of.”

She adds that the scope of services is continually expanding, including into areas such as diabetes management and hypertension management. And she adds that patients who feel that they are well taken care of by a PA or nurse practitioners tend to come back.

Qualities The Little Clinic seeks are “someone who listens, can build a relationship with [patients], who wants to be in a place that meets the needs of the community,” Marti says.

But Brenneman says work in a retail clinic is best for the PA who likes variety on the job – who “Can take care of a medical issue and move on.”

“For new graduates interested in a model that allows them to see primary care patients of all ages but not the high acuity of an emergency room, this is a good fit,” he says.

Lyons says that he would advise new PA grads not to start their careers in a retail clinic because they may not have an opportunity to use their training. “I have some serious reservations about new grads going into these positions because the scope of practice is intentionally limited.

“The kinds of training PAs get is very much hands-on,” he says, but in retail clinics they won’t sew up lacerations, they won’t cast fractures. “These are skills that PAs have worked very hard to obtain in training and they are not done in convenient care. In six months they could lose those skills.”

For him, however, working in a retail clinic at the end of his 37-year career, was a good fit. “I was nearing retirement and I could work 36-40 hours a week instead of 50-60 hours a week.”

Joyce Routson is a journalist on the HEALTHeCAREERS.com News Beat Team who has written about healthcare, labor and recruiting for a number of publications including the Contra Costa Times, NurseWeek and Staffing Industry Report. A resident of the San Francisco Bay Area, she also works as an editor at Industry Intelligence Inc.